Pilomatricoma in the infraorbital region

Abstract

Key clinical message: Pilomatricoma, a rare benign skin tumor arising from hair follicle matrix cells, warrants consideration in the evaluation of subcutaneous nodules or masses, especially when presenting as painless and firm lesions. Accurate diagnosis hinges on histopathological examination, underscoring the significance of clinician vigilance and prompt intervention.

Abstract: Pilomatricoma, also referred to as Pilomatrixomas or Calcifying epithelioma of Malherbe, is a rare benign skin tumor derived from hair follicle matrix cells, presents a diagnostic challenge due to its diverse clinical manifestations. Females are more commonly affected by Pilomatricoma. This condition typically manifests as a painless, firm, and slowly progressive lesion. Histopathological analysis shows characteristic findings, such as basaloid cells at the periphery and shadow cells centrally. Immunohistochemical studies assess the expression of cytokeratin's associated with hair matrix differentiation. Complete surgical excision remains the cornerstone of treatment, ensuring favorable outcomes and minimizing the risk of recurrence. Awareness of this entity among clinicians is essential for timely recognition and appropriate intervention. In this specific case-study, we present a case of Pilomatricoma situated in the lower left orbital region of a 32-year-old male individual who had been noticing swelling in that vicinity over the preceding 7 months.

Keywords: Pilomatricoma; basaloid cells; cytokeratin, hair follicles, infraorbital region; shadow cells/ghost cells, skin tumor.

FIGURE 1

Clinical presentation.

FIGURE 2

Macroscopic findings.

FIGURE 3

Scanner view showing islands of basaloid cells (black arrow) and ghost cells (white arrow).

FIGURE 4

Islands of basaloid cells (black arrow) and ghost cells (white arrow) in 10x magnification.

FIGURE 5

Ghost cells in 40x magnification (black arrow).

FIGURE 6

Morphological stages of pilomatricoma.